|
PR OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA
|
Professional
|
Both
|
$1,115.32
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
z26735
|
| Min. Negotiated Rate |
$499.03 |
| Max. Negotiated Rate |
$83,700.00 |
| Rate for Payer: Aetna Commercial |
$556.50
|
| Rate for Payer: Aetna Commercial |
$556.50
|
| Rate for Payer: Aetna Medicare |
$556.50
|
| Rate for Payer: Aetna Medicare |
$556.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$575.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$575.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$575.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$575.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$575.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$575.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$575.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$575.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$548.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$548.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$639.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$639.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$612.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$612.15
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$675.02
|
| Rate for Payer: Centivo All Commercial |
$862.58
|
| Rate for Payer: Centivo All Commercial |
$862.58
|
| Rate for Payer: Cigna All Commercial |
$556.50
|
| Rate for Payer: Cigna All Commercial |
$556.50
|
| Rate for Payer: CORVEL All Commercial |
$556.50
|
| Rate for Payer: CORVEL All Commercial |
$556.50
|
| Rate for Payer: Coventry All Commercial |
$667.80
|
| Rate for Payer: Coventry All Commercial |
$667.80
|
| Rate for Payer: Encore All Commercial |
$556.50
|
| Rate for Payer: Encore All Commercial |
$556.50
|
| Rate for Payer: Frontpath All Commercial |
$768.27
|
| Rate for Payer: Frontpath All Commercial |
$768.27
|
| Rate for Payer: Humana ChoiceCare |
$499.03
|
| Rate for Payer: Humana ChoiceCare |
$499.03
|
| Rate for Payer: Humana Medicare |
$556.50
|
| Rate for Payer: Humana Medicare |
$556.50
|
| Rate for Payer: Lucent All Commercial |
$779.10
|
| Rate for Payer: Lucent All Commercial |
$779.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$893.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$893.00
|
| Rate for Payer: Managed Health Services Medicaid |
$548.55
|
| Rate for Payer: Managed Health Services Medicaid |
$548.55
|
| Rate for Payer: MDWise Medicaid |
$548.55
|
| Rate for Payer: MDWise Medicaid |
$548.55
|
| Rate for Payer: PHCS All Commercial |
$556.50
|
| Rate for Payer: PHCS All Commercial |
$556.50
|
| Rate for Payer: PHP All Commercial |
$947.21
|
| Rate for Payer: PHP All Commercial |
$947.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$556.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$556.50
|
| Rate for Payer: Sagamore Health Network All Products |
$556.50
|
| Rate for Payer: Sagamore Health Network All Products |
$556.50
|
| Rate for Payer: Signature Care EPO |
$685.10
|
| Rate for Payer: Signature Care EPO |
$685.10
|
| Rate for Payer: Signature Care PPO |
$685.10
|
| Rate for Payer: Signature Care PPO |
$685.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83,700.00
|
| Rate for Payer: United Healthcare Commercial |
$605.41
|
| Rate for Payer: United Healthcare Commercial |
$605.41
|
| Rate for Payer: United Healthcare Medicare |
$544.37
|
| Rate for Payer: United Healthcare Medicare |
$544.37
|
|
|
PR OPEN TX RADIAL HEAD/NECK FRACTURE
|
Professional
|
Both
|
$1,228.26
|
|
|
Service Code
|
CPT 24665
|
| Hospital Charge Code |
z24665
|
| Min. Negotiated Rate |
$599.99 |
| Max. Negotiated Rate |
$92,200.00 |
| Rate for Payer: Aetna Commercial |
$615.01
|
| Rate for Payer: Aetna Commercial |
$615.01
|
| Rate for Payer: Aetna Medicare |
$615.01
|
| Rate for Payer: Aetna Medicare |
$615.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$798.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$798.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$798.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$798.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$798.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$798.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$798.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$798.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$604.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$604.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$707.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$707.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$676.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$676.51
|
| Rate for Payer: Cash Price |
$761.52
|
| Rate for Payer: Cash Price |
$743.99
|
| Rate for Payer: Centivo All Commercial |
$953.27
|
| Rate for Payer: Centivo All Commercial |
$953.27
|
| Rate for Payer: Cigna All Commercial |
$615.01
|
| Rate for Payer: Cigna All Commercial |
$615.01
|
| Rate for Payer: CORVEL All Commercial |
$615.01
|
| Rate for Payer: CORVEL All Commercial |
$615.01
|
| Rate for Payer: Coventry All Commercial |
$738.01
|
| Rate for Payer: Coventry All Commercial |
$738.01
|
| Rate for Payer: Encore All Commercial |
$615.01
|
| Rate for Payer: Encore All Commercial |
$615.01
|
| Rate for Payer: Frontpath All Commercial |
$851.54
|
| Rate for Payer: Frontpath All Commercial |
$851.54
|
| Rate for Payer: Humana ChoiceCare |
$679.62
|
| Rate for Payer: Humana ChoiceCare |
$679.62
|
| Rate for Payer: Humana Medicare |
$615.01
|
| Rate for Payer: Humana Medicare |
$615.01
|
| Rate for Payer: Lucent All Commercial |
$861.01
|
| Rate for Payer: Lucent All Commercial |
$861.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$984.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$984.00
|
| Rate for Payer: Managed Health Services Medicaid |
$604.10
|
| Rate for Payer: Managed Health Services Medicaid |
$604.10
|
| Rate for Payer: MDWise Medicaid |
$604.10
|
| Rate for Payer: MDWise Medicaid |
$604.10
|
| Rate for Payer: PHCS All Commercial |
$615.01
|
| Rate for Payer: PHCS All Commercial |
$615.01
|
| Rate for Payer: PHP All Commercial |
$1,043.98
|
| Rate for Payer: PHP All Commercial |
$1,043.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$615.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$615.01
|
| Rate for Payer: Sagamore Health Network All Products |
$615.01
|
| Rate for Payer: Sagamore Health Network All Products |
$615.01
|
| Rate for Payer: Signature Care EPO |
$908.65
|
| Rate for Payer: Signature Care EPO |
$908.65
|
| Rate for Payer: Signature Care PPO |
$908.65
|
| Rate for Payer: Signature Care PPO |
$908.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92,200.00
|
| Rate for Payer: United Healthcare Commercial |
$693.40
|
| Rate for Payer: United Healthcare Commercial |
$693.40
|
| Rate for Payer: United Healthcare Medicare |
$599.99
|
| Rate for Payer: United Healthcare Medicare |
$599.99
|
|
|
PR OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC
|
Professional
|
Both
|
$1,362.38
|
|
|
Service Code
|
CPT 24666
|
| Hospital Charge Code |
z24666
|
| Min. Negotiated Rate |
$667.25 |
| Max. Negotiated Rate |
$102,600.00 |
| Rate for Payer: Aetna Commercial |
$683.58
|
| Rate for Payer: Aetna Commercial |
$683.58
|
| Rate for Payer: Aetna Medicare |
$683.58
|
| Rate for Payer: Aetna Medicare |
$683.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$964.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$964.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$964.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$964.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$964.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$964.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$964.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$964.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$670.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$670.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$786.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$786.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$751.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$751.94
|
| Rate for Payer: Cash Price |
$844.68
|
| Rate for Payer: Cash Price |
$827.39
|
| Rate for Payer: Centivo All Commercial |
$1,059.55
|
| Rate for Payer: Centivo All Commercial |
$1,059.55
|
| Rate for Payer: Cigna All Commercial |
$683.58
|
| Rate for Payer: Cigna All Commercial |
$683.58
|
| Rate for Payer: CORVEL All Commercial |
$683.58
|
| Rate for Payer: CORVEL All Commercial |
$683.58
|
| Rate for Payer: Coventry All Commercial |
$820.30
|
| Rate for Payer: Coventry All Commercial |
$820.30
|
| Rate for Payer: Encore All Commercial |
$683.58
|
| Rate for Payer: Encore All Commercial |
$683.58
|
| Rate for Payer: Frontpath All Commercial |
$949.39
|
| Rate for Payer: Frontpath All Commercial |
$949.39
|
| Rate for Payer: Humana ChoiceCare |
$764.71
|
| Rate for Payer: Humana ChoiceCare |
$764.71
|
| Rate for Payer: Humana Medicare |
$683.58
|
| Rate for Payer: Humana Medicare |
$683.58
|
| Rate for Payer: Lucent All Commercial |
$957.01
|
| Rate for Payer: Lucent All Commercial |
$957.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,094.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,094.00
|
| Rate for Payer: Managed Health Services Medicaid |
$670.08
|
| Rate for Payer: Managed Health Services Medicaid |
$670.08
|
| Rate for Payer: MDWise Medicaid |
$670.08
|
| Rate for Payer: MDWise Medicaid |
$670.08
|
| Rate for Payer: PHCS All Commercial |
$683.58
|
| Rate for Payer: PHCS All Commercial |
$683.58
|
| Rate for Payer: PHP All Commercial |
$1,161.02
|
| Rate for Payer: PHP All Commercial |
$1,161.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$683.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$683.58
|
| Rate for Payer: Sagamore Health Network All Products |
$683.58
|
| Rate for Payer: Sagamore Health Network All Products |
$683.58
|
| Rate for Payer: Signature Care EPO |
$1,024.25
|
| Rate for Payer: Signature Care EPO |
$1,024.25
|
| Rate for Payer: Signature Care PPO |
$1,024.25
|
| Rate for Payer: Signature Care PPO |
$1,024.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$102,600.00
|
| Rate for Payer: United Healthcare Commercial |
$789.11
|
| Rate for Payer: United Healthcare Commercial |
$789.11
|
| Rate for Payer: United Healthcare Medicare |
$667.25
|
| Rate for Payer: United Healthcare Medicare |
$667.25
|
|
|
PR OPEN TX RADIAL & ULNAR SHAFT FX FIX RADIUS AND ULNA
|
Professional
|
Both
|
$1,679.04
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
z25575
|
| Min. Negotiated Rate |
$821.70 |
| Max. Negotiated Rate |
$126,300.00 |
| Rate for Payer: Aetna Commercial |
$842.54
|
| Rate for Payer: Aetna Commercial |
$842.54
|
| Rate for Payer: Aetna Medicare |
$842.54
|
| Rate for Payer: Aetna Medicare |
$842.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,037.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,037.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,037.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,037.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,037.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,037.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,037.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,037.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$825.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$825.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$968.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$968.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$926.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$926.79
|
| Rate for Payer: Cash Price |
$1,041.00
|
| Rate for Payer: Cash Price |
$1,018.91
|
| Rate for Payer: Centivo All Commercial |
$1,305.94
|
| Rate for Payer: Centivo All Commercial |
$1,305.94
|
| Rate for Payer: Cigna All Commercial |
$842.54
|
| Rate for Payer: Cigna All Commercial |
$842.54
|
| Rate for Payer: CORVEL All Commercial |
$842.54
|
| Rate for Payer: CORVEL All Commercial |
$842.54
|
| Rate for Payer: Coventry All Commercial |
$1,011.05
|
| Rate for Payer: Coventry All Commercial |
$1,011.05
|
| Rate for Payer: Encore All Commercial |
$842.54
|
| Rate for Payer: Encore All Commercial |
$842.54
|
| Rate for Payer: Frontpath All Commercial |
$1,172.29
|
| Rate for Payer: Frontpath All Commercial |
$1,172.29
|
| Rate for Payer: Humana ChoiceCare |
$867.16
|
| Rate for Payer: Humana ChoiceCare |
$867.16
|
| Rate for Payer: Humana Medicare |
$842.54
|
| Rate for Payer: Humana Medicare |
$842.54
|
| Rate for Payer: Lucent All Commercial |
$1,179.56
|
| Rate for Payer: Lucent All Commercial |
$1,179.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,348.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,348.00
|
| Rate for Payer: Managed Health Services Medicaid |
$825.81
|
| Rate for Payer: Managed Health Services Medicaid |
$825.81
|
| Rate for Payer: MDWise Medicaid |
$825.81
|
| Rate for Payer: MDWise Medicaid |
$825.81
|
| Rate for Payer: PHCS All Commercial |
$842.54
|
| Rate for Payer: PHCS All Commercial |
$842.54
|
| Rate for Payer: PHP All Commercial |
$1,429.76
|
| Rate for Payer: PHP All Commercial |
$1,429.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$842.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$842.54
|
| Rate for Payer: Sagamore Health Network All Products |
$842.54
|
| Rate for Payer: Sagamore Health Network All Products |
$842.54
|
| Rate for Payer: Signature Care EPO |
$1,155.15
|
| Rate for Payer: Signature Care EPO |
$1,155.15
|
| Rate for Payer: Signature Care PPO |
$1,155.15
|
| Rate for Payer: Signature Care PPO |
$1,155.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126,300.00
|
| Rate for Payer: United Healthcare Commercial |
$961.34
|
| Rate for Payer: United Healthcare Commercial |
$961.34
|
| Rate for Payer: United Healthcare Medicare |
$821.70
|
| Rate for Payer: United Healthcare Medicare |
$821.70
|
|
|
PR OPEN TX RADIAL & ULNAR SHAFT FX FIX RADIUS OR ULNA
|
Professional
|
Both
|
$1,260.20
|
|
|
Service Code
|
CPT 25574
|
| Hospital Charge Code |
z25574
|
| Min. Negotiated Rate |
$614.22 |
| Max. Negotiated Rate |
$1,073.34 |
| Rate for Payer: Aetna Commercial |
$630.14
|
| Rate for Payer: Aetna Commercial |
$630.14
|
| Rate for Payer: Aetna Medicare |
$630.14
|
| Rate for Payer: Aetna Medicare |
$630.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$619.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$619.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$724.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$724.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$693.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$693.15
|
| Rate for Payer: Cash Price |
$781.32
|
| Rate for Payer: Cash Price |
$764.91
|
| Rate for Payer: Centivo All Commercial |
$976.72
|
| Rate for Payer: Centivo All Commercial |
$976.72
|
| Rate for Payer: Cigna All Commercial |
$630.14
|
| Rate for Payer: Cigna All Commercial |
$630.14
|
| Rate for Payer: CORVEL All Commercial |
$630.14
|
| Rate for Payer: CORVEL All Commercial |
$630.14
|
| Rate for Payer: Coventry All Commercial |
$756.17
|
| Rate for Payer: Coventry All Commercial |
$756.17
|
| Rate for Payer: Encore All Commercial |
$630.14
|
| Rate for Payer: Encore All Commercial |
$630.14
|
| Rate for Payer: Frontpath All Commercial |
$874.28
|
| Rate for Payer: Frontpath All Commercial |
$874.28
|
| Rate for Payer: Humana ChoiceCare |
$614.22
|
| Rate for Payer: Humana ChoiceCare |
$614.22
|
| Rate for Payer: Humana Medicare |
$630.14
|
| Rate for Payer: Humana Medicare |
$630.14
|
| Rate for Payer: Lucent All Commercial |
$882.20
|
| Rate for Payer: Lucent All Commercial |
$882.20
|
| Rate for Payer: Managed Health Services Medicaid |
$619.81
|
| Rate for Payer: Managed Health Services Medicaid |
$619.81
|
| Rate for Payer: MDWise Medicaid |
$619.81
|
| Rate for Payer: MDWise Medicaid |
$619.81
|
| Rate for Payer: PHCS All Commercial |
$630.14
|
| Rate for Payer: PHCS All Commercial |
$630.14
|
| Rate for Payer: PHP All Commercial |
$1,073.34
|
| Rate for Payer: PHP All Commercial |
$1,073.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$630.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$630.14
|
| Rate for Payer: Sagamore Health Network All Products |
$630.14
|
| Rate for Payer: Sagamore Health Network All Products |
$630.14
|
| Rate for Payer: Signature Care EPO |
$819.40
|
| Rate for Payer: Signature Care EPO |
$819.40
|
| Rate for Payer: Signature Care PPO |
$819.40
|
| Rate for Payer: Signature Care PPO |
$819.40
|
| Rate for Payer: United Healthcare Commercial |
$705.69
|
| Rate for Payer: United Healthcare Commercial |
$705.69
|
| Rate for Payer: United Healthcare Medicare |
$616.86
|
| Rate for Payer: United Healthcare Medicare |
$616.86
|
|
|
PR OPEN TX TARSAL FRACTURE XCP TALUS &CALCANEUS EA
|
Professional
|
Both
|
$1,203.60
|
|
|
Service Code
|
CPT 28465
|
| Hospital Charge Code |
z28465
|
| Min. Negotiated Rate |
$576.92 |
| Max. Negotiated Rate |
$89,600.00 |
| Rate for Payer: Aetna Commercial |
$599.68
|
| Rate for Payer: Aetna Commercial |
$599.68
|
| Rate for Payer: Aetna Medicare |
$599.68
|
| Rate for Payer: Aetna Medicare |
$599.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$584.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$584.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$584.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$584.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$584.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$584.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$584.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$584.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$591.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$591.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$689.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$689.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$659.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$659.65
|
| Rate for Payer: Cash Price |
$746.23
|
| Rate for Payer: Cash Price |
$722.49
|
| Rate for Payer: Centivo All Commercial |
$929.50
|
| Rate for Payer: Centivo All Commercial |
$929.50
|
| Rate for Payer: Cigna All Commercial |
$599.68
|
| Rate for Payer: Cigna All Commercial |
$599.68
|
| Rate for Payer: CORVEL All Commercial |
$599.68
|
| Rate for Payer: CORVEL All Commercial |
$599.68
|
| Rate for Payer: Coventry All Commercial |
$719.62
|
| Rate for Payer: Coventry All Commercial |
$719.62
|
| Rate for Payer: Encore All Commercial |
$599.68
|
| Rate for Payer: Encore All Commercial |
$599.68
|
| Rate for Payer: Frontpath All Commercial |
$820.68
|
| Rate for Payer: Frontpath All Commercial |
$820.68
|
| Rate for Payer: Humana ChoiceCare |
$576.92
|
| Rate for Payer: Humana ChoiceCare |
$576.92
|
| Rate for Payer: Humana Medicare |
$599.68
|
| Rate for Payer: Humana Medicare |
$599.68
|
| Rate for Payer: Lucent All Commercial |
$839.55
|
| Rate for Payer: Lucent All Commercial |
$839.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$956.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$956.00
|
| Rate for Payer: Managed Health Services Medicaid |
$591.98
|
| Rate for Payer: Managed Health Services Medicaid |
$591.98
|
| Rate for Payer: MDWise Medicaid |
$591.98
|
| Rate for Payer: MDWise Medicaid |
$591.98
|
| Rate for Payer: PHCS All Commercial |
$599.68
|
| Rate for Payer: PHCS All Commercial |
$599.68
|
| Rate for Payer: PHP All Commercial |
$1,013.81
|
| Rate for Payer: PHP All Commercial |
$1,013.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$599.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$599.68
|
| Rate for Payer: Sagamore Health Network All Products |
$599.68
|
| Rate for Payer: Sagamore Health Network All Products |
$599.68
|
| Rate for Payer: Signature Care EPO |
$776.05
|
| Rate for Payer: Signature Care EPO |
$776.05
|
| Rate for Payer: Signature Care PPO |
$776.05
|
| Rate for Payer: Signature Care PPO |
$776.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$89,600.00
|
| Rate for Payer: United Healthcare Commercial |
$671.26
|
| Rate for Payer: United Healthcare Commercial |
$671.26
|
| Rate for Payer: United Healthcare Medicare |
$582.65
|
| Rate for Payer: United Healthcare Medicare |
$582.65
|
|
|
PR OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR
|
Professional
|
Both
|
$1,649.70
|
|
|
Service Code
|
CPT 27535
|
| Hospital Charge Code |
z27535
|
| Min. Negotiated Rate |
$810.25 |
| Max. Negotiated Rate |
$124,600.00 |
| Rate for Payer: Aetna Commercial |
$834.87
|
| Rate for Payer: Aetna Commercial |
$834.87
|
| Rate for Payer: Aetna Medicare |
$834.87
|
| Rate for Payer: Aetna Medicare |
$834.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,145.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,145.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,145.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,145.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,145.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,145.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,145.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,145.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$811.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$811.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$960.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$960.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$918.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$918.36
|
| Rate for Payer: Cash Price |
$1,022.81
|
| Rate for Payer: Cash Price |
$1,004.71
|
| Rate for Payer: Centivo All Commercial |
$1,294.05
|
| Rate for Payer: Centivo All Commercial |
$1,294.05
|
| Rate for Payer: Cigna All Commercial |
$834.87
|
| Rate for Payer: Cigna All Commercial |
$834.87
|
| Rate for Payer: CORVEL All Commercial |
$834.87
|
| Rate for Payer: CORVEL All Commercial |
$834.87
|
| Rate for Payer: Coventry All Commercial |
$1,001.84
|
| Rate for Payer: Coventry All Commercial |
$1,001.84
|
| Rate for Payer: Encore All Commercial |
$834.87
|
| Rate for Payer: Encore All Commercial |
$834.87
|
| Rate for Payer: Frontpath All Commercial |
$1,168.44
|
| Rate for Payer: Frontpath All Commercial |
$1,168.44
|
| Rate for Payer: Humana ChoiceCare |
$940.34
|
| Rate for Payer: Humana ChoiceCare |
$940.34
|
| Rate for Payer: Humana Medicare |
$834.87
|
| Rate for Payer: Humana Medicare |
$834.87
|
| Rate for Payer: Lucent All Commercial |
$1,168.82
|
| Rate for Payer: Lucent All Commercial |
$1,168.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,329.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,329.00
|
| Rate for Payer: Managed Health Services Medicaid |
$811.38
|
| Rate for Payer: Managed Health Services Medicaid |
$811.38
|
| Rate for Payer: MDWise Medicaid |
$811.38
|
| Rate for Payer: MDWise Medicaid |
$811.38
|
| Rate for Payer: PHCS All Commercial |
$834.87
|
| Rate for Payer: PHCS All Commercial |
$834.87
|
| Rate for Payer: PHP All Commercial |
$1,409.83
|
| Rate for Payer: PHP All Commercial |
$1,409.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$834.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$834.87
|
| Rate for Payer: Sagamore Health Network All Products |
$834.87
|
| Rate for Payer: Sagamore Health Network All Products |
$834.87
|
| Rate for Payer: Signature Care EPO |
$1,258.85
|
| Rate for Payer: Signature Care EPO |
$1,258.85
|
| Rate for Payer: Signature Care PPO |
$1,258.85
|
| Rate for Payer: Signature Care PPO |
$1,258.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$124,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$124,600.00
|
| Rate for Payer: United Healthcare Commercial |
$998.53
|
| Rate for Payer: United Healthcare Commercial |
$998.53
|
| Rate for Payer: United Healthcare Medicare |
$810.25
|
| Rate for Payer: United Healthcare Medicare |
$810.25
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W FIX PST LIP
|
Professional
|
Both
|
$1,824.24
|
|
|
Service Code
|
CPT 27823
|
| Hospital Charge Code |
z27823
|
| Min. Negotiated Rate |
$895.22 |
| Max. Negotiated Rate |
$137,700.00 |
| Rate for Payer: Aetna Commercial |
$922.67
|
| Rate for Payer: Aetna Commercial |
$922.67
|
| Rate for Payer: Aetna Medicare |
$922.67
|
| Rate for Payer: Aetna Medicare |
$922.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,766.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,766.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,766.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,766.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,766.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,766.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,766.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,766.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$897.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$897.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,061.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,061.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,014.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,014.94
|
| Rate for Payer: Cash Price |
$1,131.03
|
| Rate for Payer: Cash Price |
$1,110.07
|
| Rate for Payer: Centivo All Commercial |
$1,430.14
|
| Rate for Payer: Centivo All Commercial |
$1,430.14
|
| Rate for Payer: Cigna All Commercial |
$922.67
|
| Rate for Payer: Cigna All Commercial |
$922.67
|
| Rate for Payer: CORVEL All Commercial |
$922.67
|
| Rate for Payer: CORVEL All Commercial |
$922.67
|
| Rate for Payer: Coventry All Commercial |
$1,107.20
|
| Rate for Payer: Coventry All Commercial |
$1,107.20
|
| Rate for Payer: Encore All Commercial |
$922.67
|
| Rate for Payer: Encore All Commercial |
$922.67
|
| Rate for Payer: Frontpath All Commercial |
$1,279.36
|
| Rate for Payer: Frontpath All Commercial |
$1,279.36
|
| Rate for Payer: Humana ChoiceCare |
$1,064.38
|
| Rate for Payer: Humana ChoiceCare |
$1,064.38
|
| Rate for Payer: Humana Medicare |
$922.67
|
| Rate for Payer: Humana Medicare |
$922.67
|
| Rate for Payer: Lucent All Commercial |
$1,291.74
|
| Rate for Payer: Lucent All Commercial |
$1,291.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,468.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,468.00
|
| Rate for Payer: Managed Health Services Medicaid |
$897.23
|
| Rate for Payer: Managed Health Services Medicaid |
$897.23
|
| Rate for Payer: MDWise Medicaid |
$897.23
|
| Rate for Payer: MDWise Medicaid |
$897.23
|
| Rate for Payer: PHCS All Commercial |
$922.67
|
| Rate for Payer: PHCS All Commercial |
$922.67
|
| Rate for Payer: PHP All Commercial |
$1,557.69
|
| Rate for Payer: PHP All Commercial |
$1,557.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$922.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$922.67
|
| Rate for Payer: Sagamore Health Network All Products |
$922.67
|
| Rate for Payer: Sagamore Health Network All Products |
$922.67
|
| Rate for Payer: Signature Care EPO |
$1,422.05
|
| Rate for Payer: Signature Care EPO |
$1,422.05
|
| Rate for Payer: Signature Care PPO |
$1,422.05
|
| Rate for Payer: Signature Care PPO |
$1,422.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$137,700.00
|
| Rate for Payer: United Healthcare Commercial |
$1,050.56
|
| Rate for Payer: United Healthcare Commercial |
$1,050.56
|
| Rate for Payer: United Healthcare Medicare |
$895.22
|
| Rate for Payer: United Healthcare Medicare |
$895.22
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/O FIX PST LIP
|
Professional
|
Both
|
$1,621.36
|
|
|
Service Code
|
CPT 27822
|
| Hospital Charge Code |
z27822
|
| Min. Negotiated Rate |
$796.32 |
| Max. Negotiated Rate |
$122,400.00 |
| Rate for Payer: Aetna Commercial |
$821.21
|
| Rate for Payer: Aetna Commercial |
$821.21
|
| Rate for Payer: Aetna Medicare |
$821.21
|
| Rate for Payer: Aetna Medicare |
$821.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,551.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$797.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$797.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$944.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$944.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$903.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$903.33
|
| Rate for Payer: Cash Price |
$1,005.24
|
| Rate for Payer: Cash Price |
$987.44
|
| Rate for Payer: Centivo All Commercial |
$1,272.88
|
| Rate for Payer: Centivo All Commercial |
$1,272.88
|
| Rate for Payer: Cigna All Commercial |
$821.21
|
| Rate for Payer: Cigna All Commercial |
$821.21
|
| Rate for Payer: CORVEL All Commercial |
$821.21
|
| Rate for Payer: CORVEL All Commercial |
$821.21
|
| Rate for Payer: Coventry All Commercial |
$985.45
|
| Rate for Payer: Coventry All Commercial |
$985.45
|
| Rate for Payer: Encore All Commercial |
$821.21
|
| Rate for Payer: Encore All Commercial |
$821.21
|
| Rate for Payer: Frontpath All Commercial |
$1,136.46
|
| Rate for Payer: Frontpath All Commercial |
$1,136.46
|
| Rate for Payer: Humana ChoiceCare |
$938.15
|
| Rate for Payer: Humana ChoiceCare |
$938.15
|
| Rate for Payer: Humana Medicare |
$821.21
|
| Rate for Payer: Humana Medicare |
$821.21
|
| Rate for Payer: Lucent All Commercial |
$1,149.69
|
| Rate for Payer: Lucent All Commercial |
$1,149.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,306.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,306.00
|
| Rate for Payer: Managed Health Services Medicaid |
$797.44
|
| Rate for Payer: Managed Health Services Medicaid |
$797.44
|
| Rate for Payer: MDWise Medicaid |
$797.44
|
| Rate for Payer: MDWise Medicaid |
$797.44
|
| Rate for Payer: PHCS All Commercial |
$821.21
|
| Rate for Payer: PHCS All Commercial |
$821.21
|
| Rate for Payer: PHP All Commercial |
$1,385.59
|
| Rate for Payer: PHP All Commercial |
$1,385.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$821.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$821.21
|
| Rate for Payer: Sagamore Health Network All Products |
$821.21
|
| Rate for Payer: Sagamore Health Network All Products |
$821.21
|
| Rate for Payer: Signature Care EPO |
$1,248.65
|
| Rate for Payer: Signature Care EPO |
$1,248.65
|
| Rate for Payer: Signature Care PPO |
$1,248.65
|
| Rate for Payer: Signature Care PPO |
$1,248.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122,400.00
|
| Rate for Payer: United Healthcare Commercial |
$920.76
|
| Rate for Payer: United Healthcare Commercial |
$920.76
|
| Rate for Payer: United Healthcare Medicare |
$796.32
|
| Rate for Payer: United Healthcare Medicare |
$796.32
|
|
|
PR OPEN TX ULNAR FRACTURE PROX END
|
Professional
|
Both
|
$1,220.68
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
z24685
|
| Min. Negotiated Rate |
$596.27 |
| Max. Negotiated Rate |
$91,700.00 |
| Rate for Payer: Aetna Commercial |
$610.69
|
| Rate for Payer: Aetna Commercial |
$610.69
|
| Rate for Payer: Aetna Medicare |
$610.69
|
| Rate for Payer: Aetna Medicare |
$610.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$873.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$873.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$873.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$873.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$873.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$873.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$873.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$873.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$600.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$600.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$702.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$702.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$671.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$671.76
|
| Rate for Payer: Cash Price |
$756.82
|
| Rate for Payer: Cash Price |
$739.37
|
| Rate for Payer: Centivo All Commercial |
$946.57
|
| Rate for Payer: Centivo All Commercial |
$946.57
|
| Rate for Payer: Cigna All Commercial |
$610.69
|
| Rate for Payer: Cigna All Commercial |
$610.69
|
| Rate for Payer: CORVEL All Commercial |
$610.69
|
| Rate for Payer: CORVEL All Commercial |
$610.69
|
| Rate for Payer: Coventry All Commercial |
$732.83
|
| Rate for Payer: Coventry All Commercial |
$732.83
|
| Rate for Payer: Encore All Commercial |
$610.69
|
| Rate for Payer: Encore All Commercial |
$610.69
|
| Rate for Payer: Frontpath All Commercial |
$846.40
|
| Rate for Payer: Frontpath All Commercial |
$846.40
|
| Rate for Payer: Humana ChoiceCare |
$710.92
|
| Rate for Payer: Humana ChoiceCare |
$710.92
|
| Rate for Payer: Humana Medicare |
$610.69
|
| Rate for Payer: Humana Medicare |
$610.69
|
| Rate for Payer: Lucent All Commercial |
$854.97
|
| Rate for Payer: Lucent All Commercial |
$854.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$978.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$978.00
|
| Rate for Payer: Managed Health Services Medicaid |
$600.38
|
| Rate for Payer: Managed Health Services Medicaid |
$600.38
|
| Rate for Payer: MDWise Medicaid |
$600.38
|
| Rate for Payer: MDWise Medicaid |
$600.38
|
| Rate for Payer: PHCS All Commercial |
$610.69
|
| Rate for Payer: PHCS All Commercial |
$610.69
|
| Rate for Payer: PHP All Commercial |
$1,037.51
|
| Rate for Payer: PHP All Commercial |
$1,037.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$610.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$610.69
|
| Rate for Payer: Sagamore Health Network All Products |
$610.69
|
| Rate for Payer: Sagamore Health Network All Products |
$610.69
|
| Rate for Payer: Signature Care EPO |
$952.85
|
| Rate for Payer: Signature Care EPO |
$952.85
|
| Rate for Payer: Signature Care PPO |
$952.85
|
| Rate for Payer: Signature Care PPO |
$952.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$91,700.00
|
| Rate for Payer: United Healthcare Commercial |
$696.34
|
| Rate for Payer: United Healthcare Commercial |
$696.34
|
| Rate for Payer: United Healthcare Medicare |
$596.27
|
| Rate for Payer: United Healthcare Medicare |
$596.27
|
|
|
PROPOFOL 10 MG/ML IV EMUL
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Commercial |
$24.52
|
| Rate for Payer: Aetna Commercial |
$49.04
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Aetna Medicare |
$18.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.45
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$18.01
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| Rate for Payer: Centivo All Commercial |
$31.61
|
| Rate for Payer: Centivo All Commercial |
$15.80
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: Cigna All Commercial |
$25.07
|
| Rate for Payer: Cigna All Commercial |
$50.14
|
| Rate for Payer: CORVEL All Commercial |
$54.03
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: CORVEL All Commercial |
$27.02
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Coventry All Commercial |
$25.56
|
| Rate for Payer: Coventry All Commercial |
$51.13
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Encore All Commercial |
$53.48
|
| Rate for Payer: Encore All Commercial |
$26.74
|
| Rate for Payer: Frontpath All Commercial |
$26.73
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Frontpath All Commercial |
$53.45
|
| Rate for Payer: Humana ChoiceCare |
$25.09
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana ChoiceCare |
$50.18
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: Humana Medicare |
$18.59
|
| Rate for Payer: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$15.80
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| Rate for Payer: Lucent All Commercial |
$31.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.29
|
| Rate for Payer: PHCS All Commercial |
$43.58
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHCS All Commercial |
$21.79
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: PHP All Commercial |
$22.03
|
| Rate for Payer: PHP All Commercial |
$44.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.33
|
| Rate for Payer: Sagamore Health Network All Products |
$22.43
|
| Rate for Payer: Sagamore Health Network All Products |
$44.85
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$24.11
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care EPO |
$48.22
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$51.13
|
| Rate for Payer: Signature Care PPO |
$25.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.38
|
| Rate for Payer: United Healthcare Commercial |
$22.89
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$45.78
|
| Rate for Payer: United Healthcare Medicare |
$18.59
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
| Rate for Payer: United Healthcare Medicare |
$9.30
|
|
|
PROPOFOL 10 MG/ML IV EMUL
|
Facility
|
IP
|
$29.05
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.79 |
| Max. Negotiated Rate |
$27.02 |
| Rate for Payer: Aetna Commercial |
$25.10
|
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Aetna Commercial |
$50.20
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$18.01
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cigna All Commercial |
$25.07
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: Cigna All Commercial |
$50.14
|
| Rate for Payer: CORVEL All Commercial |
$54.03
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: CORVEL All Commercial |
$27.02
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Coventry All Commercial |
$51.13
|
| Rate for Payer: Coventry All Commercial |
$25.56
|
| Rate for Payer: Encore All Commercial |
$26.74
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Encore All Commercial |
$53.48
|
| Rate for Payer: Frontpath All Commercial |
$53.45
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Frontpath All Commercial |
$26.73
|
| Rate for Payer: Humana ChoiceCare |
$25.09
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana ChoiceCare |
$50.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.29
|
| Rate for Payer: PHCS All Commercial |
$21.79
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHCS All Commercial |
$43.58
|
| Rate for Payer: PHP All Commercial |
$22.03
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: PHP All Commercial |
$44.06
|
| Rate for Payer: Sagamore Health Network All Products |
$44.85
|
| Rate for Payer: Sagamore Health Network All Products |
$22.43
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$24.11
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care EPO |
$48.22
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$51.13
|
| Rate for Payer: Signature Care PPO |
$25.56
|
| Rate for Payer: United Healthcare Commercial |
$22.89
|
| Rate for Payer: United Healthcare Commercial |
$45.78
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
PROPOFOL 10 MG/ML IV INFUSION
|
Facility
|
IP
|
$58.10
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
408011150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$54.03 |
| Rate for Payer: Aetna Commercial |
$50.20
|
| Rate for Payer: Aetna Commercial |
$25.10
|
| Rate for Payer: Cash Price |
$18.01
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cigna All Commercial |
$25.07
|
| Rate for Payer: Cigna All Commercial |
$50.14
|
| Rate for Payer: CORVEL All Commercial |
$27.02
|
| Rate for Payer: CORVEL All Commercial |
$54.03
|
| Rate for Payer: Coventry All Commercial |
$51.13
|
| Rate for Payer: Coventry All Commercial |
$25.56
|
| Rate for Payer: Encore All Commercial |
$53.48
|
| Rate for Payer: Encore All Commercial |
$26.74
|
| Rate for Payer: Frontpath All Commercial |
$26.73
|
| Rate for Payer: Frontpath All Commercial |
$53.45
|
| Rate for Payer: Humana ChoiceCare |
$25.09
|
| Rate for Payer: Humana ChoiceCare |
$50.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.29
|
| Rate for Payer: PHCS All Commercial |
$43.58
|
| Rate for Payer: PHCS All Commercial |
$21.79
|
| Rate for Payer: PHP All Commercial |
$22.03
|
| Rate for Payer: PHP All Commercial |
$44.06
|
| Rate for Payer: Sagamore Health Network All Products |
$44.85
|
| Rate for Payer: Sagamore Health Network All Products |
$22.43
|
| Rate for Payer: Signature Care EPO |
$48.22
|
| Rate for Payer: Signature Care EPO |
$24.11
|
| Rate for Payer: Signature Care PPO |
$25.56
|
| Rate for Payer: Signature Care PPO |
$51.13
|
| Rate for Payer: United Healthcare Commercial |
$22.89
|
| Rate for Payer: United Healthcare Commercial |
$45.78
|
|
|
PROPOFOL 10 MG/ML IV INFUSION
|
Facility
|
OP
|
$58.10
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
408011150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$54.03 |
| Rate for Payer: Aetna Commercial |
$49.04
|
| Rate for Payer: Aetna Commercial |
$24.52
|
| Rate for Payer: Aetna Medicare |
$9.30
|
| Rate for Payer: Aetna Medicare |
$18.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.45
|
| Rate for Payer: Cash Price |
$36.02
|
| Rate for Payer: Cash Price |
$18.01
|
| Rate for Payer: Centivo All Commercial |
$31.61
|
| Rate for Payer: Centivo All Commercial |
$15.80
|
| Rate for Payer: Cigna All Commercial |
$25.07
|
| Rate for Payer: Cigna All Commercial |
$50.14
|
| Rate for Payer: CORVEL All Commercial |
$27.02
|
| Rate for Payer: CORVEL All Commercial |
$54.03
|
| Rate for Payer: Coventry All Commercial |
$25.56
|
| Rate for Payer: Coventry All Commercial |
$51.13
|
| Rate for Payer: Encore All Commercial |
$26.74
|
| Rate for Payer: Encore All Commercial |
$53.48
|
| Rate for Payer: Frontpath All Commercial |
$53.45
|
| Rate for Payer: Frontpath All Commercial |
$26.73
|
| Rate for Payer: Humana ChoiceCare |
$50.18
|
| Rate for Payer: Humana ChoiceCare |
$25.09
|
| Rate for Payer: Humana Medicare |
$18.59
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: Lucent All Commercial |
$15.80
|
| Rate for Payer: Lucent All Commercial |
$31.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.14
|
| Rate for Payer: PHCS All Commercial |
$43.58
|
| Rate for Payer: PHCS All Commercial |
$21.79
|
| Rate for Payer: PHP All Commercial |
$22.03
|
| Rate for Payer: PHP All Commercial |
$44.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.66
|
| Rate for Payer: Sagamore Health Network All Products |
$22.43
|
| Rate for Payer: Sagamore Health Network All Products |
$44.85
|
| Rate for Payer: Signature Care EPO |
$48.22
|
| Rate for Payer: Signature Care EPO |
$24.11
|
| Rate for Payer: Signature Care PPO |
$25.56
|
| Rate for Payer: Signature Care PPO |
$51.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.69
|
| Rate for Payer: United Healthcare Commercial |
$22.89
|
| Rate for Payer: United Healthcare Commercial |
$45.78
|
| Rate for Payer: United Healthcare Medicare |
$9.30
|
| Rate for Payer: United Healthcare Medicare |
$18.59
|
|
|
PROPRANOLOL 10 MG ORAL TAB
|
Facility
|
OP
|
$1.62
|
|
|
Service Code
|
NDC 60687058711
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna Commercial |
$1.37
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Centivo All Commercial |
$0.88
|
| Rate for Payer: Cigna All Commercial |
$1.40
|
| Rate for Payer: CORVEL All Commercial |
$1.51
|
| Rate for Payer: Coventry All Commercial |
$1.43
|
| Rate for Payer: Encore All Commercial |
$1.49
|
| Rate for Payer: Frontpath All Commercial |
$1.49
|
| Rate for Payer: Humana ChoiceCare |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.52
|
| Rate for Payer: Lucent All Commercial |
$0.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.46
|
| Rate for Payer: PHCS All Commercial |
$1.22
|
| Rate for Payer: PHP All Commercial |
$1.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.63
|
| Rate for Payer: Sagamore Health Network All Products |
$1.25
|
| Rate for Payer: Signature Care EPO |
$1.35
|
| Rate for Payer: Signature Care PPO |
$1.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.38
|
| Rate for Payer: United Healthcare Commercial |
$1.28
|
| Rate for Payer: United Healthcare Medicare |
$0.52
|
|
|
PROPRANOLOL 10 MG ORAL TAB
|
Facility
|
OP
|
$1.62
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna Commercial |
$1.37
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Centivo All Commercial |
$0.88
|
| Rate for Payer: Cigna All Commercial |
$1.40
|
| Rate for Payer: CORVEL All Commercial |
$1.51
|
| Rate for Payer: Coventry All Commercial |
$1.43
|
| Rate for Payer: Encore All Commercial |
$1.49
|
| Rate for Payer: Frontpath All Commercial |
$1.49
|
| Rate for Payer: Humana ChoiceCare |
$1.40
|
| Rate for Payer: Humana Medicare |
$0.52
|
| Rate for Payer: Lucent All Commercial |
$0.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.46
|
| Rate for Payer: PHCS All Commercial |
$1.22
|
| Rate for Payer: PHP All Commercial |
$1.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.63
|
| Rate for Payer: Sagamore Health Network All Products |
$1.25
|
| Rate for Payer: Signature Care EPO |
$1.35
|
| Rate for Payer: Signature Care PPO |
$1.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.38
|
| Rate for Payer: United Healthcare Commercial |
$1.28
|
| Rate for Payer: United Healthcare Medicare |
$0.52
|
|
|
PROPRANOLOL 10 MG ORAL TAB
|
Facility
|
IP
|
$1.62
|
|
|
Service Code
|
NDC 60687058711
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna All Commercial |
$1.40
|
| Rate for Payer: CORVEL All Commercial |
$1.51
|
| Rate for Payer: Coventry All Commercial |
$1.43
|
| Rate for Payer: Encore All Commercial |
$1.49
|
| Rate for Payer: Frontpath All Commercial |
$1.49
|
| Rate for Payer: Humana ChoiceCare |
$1.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.46
|
| Rate for Payer: PHCS All Commercial |
$1.22
|
| Rate for Payer: PHP All Commercial |
$1.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1.25
|
| Rate for Payer: Signature Care EPO |
$1.35
|
| Rate for Payer: Signature Care PPO |
$1.43
|
| Rate for Payer: United Healthcare Commercial |
$1.28
|
|
|
PROPRANOLOL 10 MG ORAL TAB
|
Facility
|
IP
|
$1.62
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna All Commercial |
$1.40
|
| Rate for Payer: CORVEL All Commercial |
$1.51
|
| Rate for Payer: Coventry All Commercial |
$1.43
|
| Rate for Payer: Encore All Commercial |
$1.49
|
| Rate for Payer: Frontpath All Commercial |
$1.49
|
| Rate for Payer: Humana ChoiceCare |
$1.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.46
|
| Rate for Payer: PHCS All Commercial |
$1.22
|
| Rate for Payer: PHP All Commercial |
$1.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1.25
|
| Rate for Payer: Signature Care EPO |
$1.35
|
| Rate for Payer: Signature Care PPO |
$1.43
|
| Rate for Payer: United Healthcare Commercial |
$1.28
|
|
|
PROPRANOLOL 80 MG ORAL CS24
|
Facility
|
OP
|
$5.45
|
|
|
Service Code
|
NDC 51991081801
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$5.07 |
| Rate for Payer: Aetna Commercial |
$4.60
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.92
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Centivo All Commercial |
$2.97
|
| Rate for Payer: Cigna All Commercial |
$4.71
|
| Rate for Payer: CORVEL All Commercial |
$5.07
|
| Rate for Payer: Coventry All Commercial |
$4.80
|
| Rate for Payer: Encore All Commercial |
$5.02
|
| Rate for Payer: Frontpath All Commercial |
$5.02
|
| Rate for Payer: Humana ChoiceCare |
$4.71
|
| Rate for Payer: Humana Medicare |
$1.74
|
| Rate for Payer: Lucent All Commercial |
$2.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.91
|
| Rate for Payer: PHCS All Commercial |
$4.09
|
| Rate for Payer: PHP All Commercial |
$4.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.13
|
| Rate for Payer: Sagamore Health Network All Products |
$4.21
|
| Rate for Payer: Signature Care EPO |
$4.53
|
| Rate for Payer: Signature Care PPO |
$4.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$4.30
|
| Rate for Payer: United Healthcare Medicare |
$1.74
|
|
|
PROPRANOLOL 80 MG ORAL CS24
|
Facility
|
IP
|
$5.45
|
|
|
Service Code
|
NDC 51991081801
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$5.07 |
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cigna All Commercial |
$4.71
|
| Rate for Payer: CORVEL All Commercial |
$5.07
|
| Rate for Payer: Coventry All Commercial |
$4.80
|
| Rate for Payer: Encore All Commercial |
$5.02
|
| Rate for Payer: Frontpath All Commercial |
$5.02
|
| Rate for Payer: Humana ChoiceCare |
$4.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.91
|
| Rate for Payer: PHCS All Commercial |
$4.09
|
| Rate for Payer: PHP All Commercial |
$4.14
|
| Rate for Payer: Sagamore Health Network All Products |
$4.21
|
| Rate for Payer: Signature Care EPO |
$4.53
|
| Rate for Payer: Signature Care PPO |
$4.80
|
| Rate for Payer: United Healthcare Commercial |
$4.30
|
|
|
PROPYLENE GLYCOL-GLYCERIN 1-0.3 % OPHT DROP
|
Facility
|
OP
|
$41.69
|
|
|
Service Code
|
NDC 10119002003
|
| Hospital Charge Code |
34235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$38.77 |
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna Medicare |
$13.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.67
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Centivo All Commercial |
$22.68
|
| Rate for Payer: Cigna All Commercial |
$35.97
|
| Rate for Payer: CORVEL All Commercial |
$38.77
|
| Rate for Payer: Coventry All Commercial |
$36.68
|
| Rate for Payer: Encore All Commercial |
$38.37
|
| Rate for Payer: Frontpath All Commercial |
$38.35
|
| Rate for Payer: Humana ChoiceCare |
$36.00
|
| Rate for Payer: Humana Medicare |
$13.34
|
| Rate for Payer: Lucent All Commercial |
$22.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.52
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$31.26
|
| Rate for Payer: PHP All Commercial |
$31.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.26
|
| Rate for Payer: Sagamore Health Network All Products |
$32.18
|
| Rate for Payer: Signature Care EPO |
$34.60
|
| Rate for Payer: Signature Care PPO |
$36.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.43
|
| Rate for Payer: United Healthcare Commercial |
$32.85
|
| Rate for Payer: United Healthcare Medicare |
$13.34
|
|
|
PROPYLENE GLYCOL-GLYCERIN 1-0.3 % OPHT DROP
|
Facility
|
IP
|
$41.69
|
|
|
Service Code
|
NDC 10119002003
|
| Hospital Charge Code |
34235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.26 |
| Max. Negotiated Rate |
$38.77 |
| Rate for Payer: Aetna Commercial |
$36.02
|
| Rate for Payer: Cash Price |
$25.84
|
| Rate for Payer: Cigna All Commercial |
$35.97
|
| Rate for Payer: CORVEL All Commercial |
$38.77
|
| Rate for Payer: Coventry All Commercial |
$36.68
|
| Rate for Payer: Encore All Commercial |
$38.37
|
| Rate for Payer: Frontpath All Commercial |
$38.35
|
| Rate for Payer: Humana ChoiceCare |
$36.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.52
|
| Rate for Payer: PHCS All Commercial |
$31.26
|
| Rate for Payer: PHP All Commercial |
$31.61
|
| Rate for Payer: Sagamore Health Network All Products |
$32.18
|
| Rate for Payer: Signature Care EPO |
$34.60
|
| Rate for Payer: Signature Care PPO |
$36.68
|
| Rate for Payer: United Healthcare Commercial |
$32.85
|
|
|
PROPYLTHIOURACIL 50 MG ORAL TAB
|
Facility
|
OP
|
$15.56
|
|
|
Service Code
|
NDC 68084096495
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$14.47 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna Medicare |
$4.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.48
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Centivo All Commercial |
$8.47
|
| Rate for Payer: Cigna All Commercial |
$13.43
|
| Rate for Payer: CORVEL All Commercial |
$14.47
|
| Rate for Payer: Coventry All Commercial |
$13.69
|
| Rate for Payer: Encore All Commercial |
$14.32
|
| Rate for Payer: Frontpath All Commercial |
$14.32
|
| Rate for Payer: Humana ChoiceCare |
$13.44
|
| Rate for Payer: Humana Medicare |
$4.98
|
| Rate for Payer: Lucent All Commercial |
$8.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: PHCS All Commercial |
$11.67
|
| Rate for Payer: PHP All Commercial |
$11.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.07
|
| Rate for Payer: Sagamore Health Network All Products |
$12.01
|
| Rate for Payer: Signature Care EPO |
$12.92
|
| Rate for Payer: Signature Care PPO |
$13.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.23
|
| Rate for Payer: United Healthcare Commercial |
$12.26
|
| Rate for Payer: United Healthcare Medicare |
$4.98
|
|
|
PROPYLTHIOURACIL 50 MG ORAL TAB
|
Facility
|
IP
|
$15.56
|
|
|
Service Code
|
NDC 68084096425
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$14.47 |
| Rate for Payer: Aetna Commercial |
$13.44
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Cigna All Commercial |
$13.43
|
| Rate for Payer: CORVEL All Commercial |
$14.47
|
| Rate for Payer: Coventry All Commercial |
$13.69
|
| Rate for Payer: Encore All Commercial |
$14.32
|
| Rate for Payer: Frontpath All Commercial |
$14.32
|
| Rate for Payer: Humana ChoiceCare |
$13.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: PHCS All Commercial |
$11.67
|
| Rate for Payer: PHP All Commercial |
$11.80
|
| Rate for Payer: Sagamore Health Network All Products |
$12.01
|
| Rate for Payer: Signature Care EPO |
$12.92
|
| Rate for Payer: Signature Care PPO |
$13.69
|
| Rate for Payer: United Healthcare Commercial |
$12.26
|
|
|
PROPYLTHIOURACIL 50 MG ORAL TAB
|
Facility
|
OP
|
$15.56
|
|
|
Service Code
|
NDC 68084096425
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$14.47 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna Medicare |
$4.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.48
|
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Centivo All Commercial |
$8.47
|
| Rate for Payer: Cigna All Commercial |
$13.43
|
| Rate for Payer: CORVEL All Commercial |
$14.47
|
| Rate for Payer: Coventry All Commercial |
$13.69
|
| Rate for Payer: Encore All Commercial |
$14.32
|
| Rate for Payer: Frontpath All Commercial |
$14.32
|
| Rate for Payer: Humana ChoiceCare |
$13.44
|
| Rate for Payer: Humana Medicare |
$4.98
|
| Rate for Payer: Lucent All Commercial |
$8.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: PHCS All Commercial |
$11.67
|
| Rate for Payer: PHP All Commercial |
$11.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.07
|
| Rate for Payer: Sagamore Health Network All Products |
$12.01
|
| Rate for Payer: Signature Care EPO |
$12.92
|
| Rate for Payer: Signature Care PPO |
$13.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.23
|
| Rate for Payer: United Healthcare Commercial |
$12.26
|
| Rate for Payer: United Healthcare Medicare |
$4.98
|
|
